Knowledge, practices and adherence to COVID-19 preventive measures by community members in the Phalombe District Malawi: a cross-sectional qualitative study

Background: The COVID-19 pandemic has strained already struggling health systems in low- and middle-income countries such as Malawi. To slow the spread of the virus, the World Health Organization recommended non-pharmaceutical measures including frequent hand washing, wearing of face masks when in groups or social gatherings and maintaining physical distance. To ensure adequate uptake of these preventive measures, many communities intensified engagement, advocacy meetings and health promotion interventions. In this study, we investigated knowledge, practice and adherence towards COVID-19 preventive measures of people living in the rural community of Phalombe District of Malawi. Methods: In this cross-sectional, qualitative study, data were collected in focus group discussions and in-depth interviews. Participants were selected from six randomly selected villages under traditional authorities, namely Nazombe, Jenala and Nkhumba from Phalombe District. Data were thematically analysed to identify emerging themes. Results: Most participants knew about and were aware of, but reported poor adherence to COVID-19 preventive measures. Two major themes emerged, namely, perceived low-risk of COVID-19 and non-adherence to preventive measures. Various sub-themes emerged regarding the use of preventive measures when participating in social gatherings. These sub-themes included knowledge of preventive measures, use of face masks, observing physical distance and hand washing practices. Conclusion: People living in the rural district of Phalombe District of Malawi were able to identify COVID-19 preventive methods. Participants reported low adherence to preventive methods, which was associated with low perceived risk. Community perceptions and willingness need to be considered when mandating preventive measures for future pandemics.